The IPEM code of practice for electron dosimetry for radiotherapy beams of initial energy from 4 to 25 MeV based on an absorbed dose to water calibration

Characteristics Performance of Newly Developed Parallel Plate Chamber in Electron Beams

Background

To investigate the dosimetric performance of newly developed parallel plate chamber in electron beams.

Materials and Methods

Rosalina Instruments India Private Limited (Mumbai, Maharashtra, India) has designed and fabricated PRATT2 parallel plate chamber. The various dosimetric characteristics, including pre- and post-irradiation leakage, stability, polarity effect, chamber response with bias voltage, dose linearity, dose rate effect, and chamber absorbed dose calibration, were performed for the developed chamber. The electron beam energies of 4, 6, 8, and 15MeV were used in this study.

Results

The pre- and post-irradiation leakage of the developed chamber was within the acceptable limit. The chamber shows good stability over the electron beams used in this study. The maximum error in polarity effect was 0.7% for the developed chamber. The chamber shows the good linear response with dose, and its response is independent of the dose rate for all electron beams. The beam quality correction factor (kQ, Q0) was determined for the all electron beam energies, which was used for determination absorbed dose in electron beams.

Discussion

The developed parallel plate chamber (PRATT2) is suitable for dosimetry of electron beams in radiotherapy. The chamber is cost effective and shows precise and reproducible response. The study carried out confirms that the newly designed and fabricated ion chamber can be used in the measurement of absorbed dose for therapeutic electron beams.

Modified electron beam output calibration based on IAEA Technical Report Series 398

Purpose

The recently worldwide standard measurement of electron beam reference dosimetry include the International Atomic Energy Agency (IAEA) Technical Report Series (TRS)‐398 and Association of Physicists in Medicine (AAPM) Task Group (TG)‐51 protocols. Muir et al. have modified calibration methods for electron beam calibration based on AAPM TG‐51. They found that the use of cylindrical chambers at low energy gave acceptable results. In this study, we propose and report a modified calibration for electron beam based on IAEA TRS‐398, the standard reference dosimetry protocol worldwide.

Methods

This work was carried out with energies of 6, 8, 10, 12, and 15 MeV. The electron beam is generated from Elektra Synergy Platform and Versa HD linear accelerator. The charge readings were measured with PTW 30013, IBA CC13, Exradin A1Sl, and Exradin A11 chambers connected to the electrometer. The dose calculation uses an equation of modified calibration for electron beam using the updated kQ factor in previous work. The absorbed dose to water for electron beam is expressed in dose per monitor unit (cGy/MU). Thus, we compared dose per monitor unit (D/MU) calculation using a modified calibration to TRS‐398.

Results

In this work, we have succeeded in implementing the modified calibration of electron beam based on TRS‐398 by applying a cylindrical chamber in all energy beams and using the updated kQ factor. The ratio of the absorbed dose to water between original and modified calibration protocols of TRS‐398 (D_w) for the cylindrical chamber was 1.002 on the Elekta Synergy Platform and 1.000 on the Versa HD while for the parallel‐plate chamber it was 1.013 on the Elekta Synergy Platform and 1.014 on the Versa HD. Based on these results, both the cylindrical and parallel‐plate chambers are still within the tolerance limit allowed by the TRS‐398 protocol, which is ±2%. Therefore, modified calibration based on TRS‐398 gives acceptable results and is simpler to use clinically.

Dosimetric accuracy of a cross-calibration coefficient for plane-parallel ionization chamber obtained in low-energy electron beams using various cylindrical dosimeters

Introduction: The accuracy of the cross-calibration procedure depends on ionization chamber type, both used as reference one and under consideration. Also, the beam energy and phantom medium could influence the precision of cross calibration coefficient, resulting in a systematic error in dose estimation and thus could influence the linac beam output checking. This will result in a systematic mismatch between dose calculated in treatment planning system and delivered to the patient.

Material and methods: The usage of FC65-G, CC13 and CC01 thimble reference chambers as well as 6, 9, and 15 MeV electron beams has been analyzed. A plane-parallel PPC05 chamber was calibrated since scarce literature data are available for this dosimeter type. The influence of measurement medium and an effective point of measurement (EPOM) on obtained results are also presented.

Results: Dose reconstruction precision of ~0.1% for PPC05 chamber could be obtained when cross-calibration is based on a thimble CC13 chamber. Nd,w,Qcross obtained in beam ≥ 9MeV gives 0.1 – 0.5% precision of dose reconstruction.

Without beam quality correction, 15 MeV Nd,w,Qcross is 10% lower than Co-60 Nd,w,0. Various EPOM shifts resulted in up to 0.6% discrepancies in Nd,w,Qcross values.

Conclusions: Ionization chamber with small active volume and tissue-equivalent materials supplies more accurate cross-calibration coefficients in the range of 6 – 15 MeV electron beams. In the case of 6 and 9 MeV beams, the exact position of an effective point of measurement is of minor importance. In-water cross-calibration coefficient can be used in a solid medium without loss of dose accuracy.

Characteristics of microSilicon diode detector for electron beam dosimetry

A microSilicon™ (PTW type 60023), a new unshielded diode detector succeeding Diode E (model 60017, PTW), was characterized for electron beam dosimetry and compared with other detectors. Electron beams generated from a TrueBeam linear accelerator were measured using the microSilicon, Diode E, and microDiamond synthetic single-crystal diamond detector. Positional accuracy of microSilicon was measured by data collected in air and water. The percent depth dose (PDD), off-center ratio (OCR), dose-response linearity, dose rate dependence, and cone factors were evaluated. The PDDs were compared with data measured using a PPC40 plane-parallel ionization chamber. The maximum variations of depth of 50% and 90% of the maximum dose, and practical depth among all detectors and energies were 0.9 mm. The maximum variations of the bremsstrahlung dose among all detectors and energies were within 0.3%. OCR showed good agreement within 1% for the flat and tail regions. The microSilicon detector showed a penumbra width similar to microDiamond, whereas Diode E showed the steepest penumbra shape. All detectors showed good dose-response linearity and stability against the dose rate; only Diode E demonstrated logarithmic dose rate dependency. The cone factor measured with microSilicon was within ±1% for all energies and cone sizes. We demonstrated that the characteristics of microSilicon is suitable for electron beam dosimetry. The microSilicon detector can be a good alternative for electron beam dosimetry in terms of providing an appropriate PDD curve without corrections, high spatial resolution for OCR measurements and cone factors.

The challenge of ionisation chamber dosimetry in ultra-short pulsed high dose-rate Very High Energy Electron beams

High dose-rate radiotherapy, known as FLASH, has been shown to increase the differential response between healthy and tumour tissue. Moreover, Very High Energy Electrons (VHEEs) provide more favourable dose distributions than conventional radiotherapy electron and photon beams. Plane-parallel ionisation chambers are the recommended secondary standard systems for clinical reference dosimetry of electrons, therefore chamber response to these high energy and high dose-per-pulse beams must be well understood. Graphite calorimetry, the UK primary standard, has been employed to measure the dose delivered from a 200 MeV pulsed electron beam. This was compared to the charge measurements of a plane-parallel ionisation chamber to determine the absolute collection efficiency and infer the ion recombination factor. The dose-per-pulse measured by the calorimeter ranged between 0.03 Gy/pulse and 5.26 Gy/pulse, corresponding to collection efficiencies between 97% and 4%, respectively. Multiple recombination models currently available have been compared with experimental results. This work is directly applicable to the development of standard dosimetry protocols for VHEE radiotherapy, FLASH radiotherapy and other high dose-rate modalities. However, the use of secondary standard ionisation chambers for the dosimetry of high dose-per-pulse VHEEs has been shown to require large corrections for charge collection inefficiency.

Modeling the head of PRIMUS linear accelerator for electron-mode at 10 MeV for different applicators

OBJECTIVE

This study is to validate the utilization of Monte Carlo (MC) simulation to model the head of Primus linear accelerator, thereafter, using it to estimate the energy fluence distribution (EFD), the percentage depth dose (PDD), and beam profiles.

MATERIALS AND METHODS

The BEAMNRC code that is based on the EGSNRC code has been used for modeling the linear accelerator head for 10 MeV electron beam with different applicator sizes (10 × 10, 15 × 15, and 20 × 20 cm2 ). The phase space was acquired from BEAMNRC at the end of each applicator and then used as an input file to DOSXYZNRC and BEAMDP to calculate the EFD, PDD, and beam profiles.

RESULTS

There were a good consistency between the outcomes of the MC simulation and measured PDD and off-axis dose profiles that performed in a water phantom for all applicators. The PDD for the applicators proved to be favorable as a direct comparison of R100 , R90 , R80 , and R50 yielded results of < 2 mm, while it was 6 mm in R100 for the applicator 15 × 15 cm2 . The discrepancies in the surface doses (<3%) showed a quick decline in the build-up region and differences reached 0% within the first 2.4 mm. For the beam profiles comparison, the differences ranged from 2% (2 mm) to 3% (6 mm) for all applicators.

CONCLUSION

Our examination demonstrated that the MC simulation by BEAMNRC code was accurate in modeling the Primus linear accelerator head.

A modified formalism for electron beam reference dosimetry to improve the accuracy of linac output calibration

PURPOSE

To present and demonstrate the accuracy of a modified formalism for electron beam reference dosimetry using updated Monte Carlo calculated beam quality conversion factors.

METHODS

The proposed, simplified formalism allows the use of cylindrical ionization chambers in all electron beams (even those with low beam energies) and does not require a measured gradient correction factor. Data from a previous publication are used for beam quality conversion factors. The formalism is tested and compared to the present formalism in the AAPM TG-51 protocol with measurements made in Elekta Precise electron beams with energies between 4 MeV and 22 MeV and with fields shaped with a 10 × 10 cm² clinical applicator as well as a 20 × 20 cm² clinical applicator for the 18 MeV and 22 MeV beams. A set of six ionization chambers are used for measurements (two cylindical reference-class chambers, two scanning-type chambers and two parallel-plate chambers). Dose per monitor unit is derived using the data and formalism provided in the TG-51 protocol and with the proposed formalism and data and compared to that obtained using ionization chambers calibrated directly against primary standards for absorbed dose in electron beams.

RESULTS

The standard deviation of results using different chambers when TG-51 is followed strictly is on the order of 0.4% when parallel-plate chambers are cross-calibrated against cylindrical chambers. However, if parallel-plate chambers are directly calibrated in a cobalt-60 beam, the difference between results for these chambers is up to 2.2%. Using the proposed formalism and either directly calibrated or cross-calibrated parallel-plate chambers gives a standard deviation using different chambers of 0.4%. The difference between results that use TG-51 and the primary standard measurements are on the order of 0.6% with a maximum difference in the 4 MeV beam of 2.8%. Comparing the results obtained with the proposed formalism and the primary standard measurements are on the order of 0.4% with a maximum difference of 1.0% in the 4 MeV beam.

CONCLUSIONS

The proposed formalism and the use of updated data for beam quality conversion factors improves the consistency of results obtained with different chamber types and improves the accuracy of reference dosimetry measurements. Moreover, it is simpler than the present formalism and will be straightforward to implement clinically.

The use of 0.5rcav as an effective point of measurement for cylindrical chambers may result in a systematic shift of electron percentage depth doses

Electron dosimetry can be performed using cylindrical chambers, plane‐parallel chambers, and diode detectors. The finite volume of these detectors results in a displacement effect which is taken into account using an effective point of measurement (EPOM). Dosimetry protocols have recommended a shift of 0.5 r_cav for cylindrical chambers; however, various studies have shown that the optimal shift may deviate from this recommended value. This study investigated the effect that the selection of EPOM shift for cylindrical chamber has on percentage depth dose (PDD) curves. Depth dose curves were measured in a water phantom for electron beams with energies ranging from 6 to 18 MeV. The detectors investigated were of three different types: diodes (Diode‐E PTW 60017 and SFD IBA), cylindrical (Semiflex PTW 31010, PinPoint PTW 31015, and A12 Exradin), and parallel plate ionization chambers (Advanced Markus PTW 34045 and Markus PTW 23343). Depth dose curves measured with Diode‐E and Advanced Markus agreed within 0.2 mm at R₅₀ except for 18 MeV and extremely large field size. The PDDs measured with the Semiflex chamber and Exradin A12 were about 1.1 mm (with respect to the Advanced Markus chamber) shallower than those measured with the other detectors using a 0.5 r_cav shift. The difference between the PDDs decreased when a Pinpoint chamber, with a smaller cavity radius, was used. Agreement improved at lower energies, with the use of previously published EPOM corrections (0.3 r_cav). Therefore, the use of 0.5 r_cav as an EPOM may result in a systematic shift of the therapeutic portion of the PDD (distances < R₉₀). Our results suggest that a 0.1 r_cav shift is more appropriate for one chamber model (Semiflex PTW 31010).

Evaluation of the RayStation electron Monte Carlo dose calculation algorithm

The aim of this work was to evaluate the accuracy of the RayStation treatment planning system electron Monte Carlo algorithm against measured data for a range of clinically relevant scenarios. This was done by comparing measured percentage depth dose data (PDD) in water, profiles at oblique incidence and with heterogeneities in the beam path, and output factor data and that generated using the RayStation treatment planning system Monte Carlo VMC++ based calculation algorithm. While electron treatments are widely employed in the radiotherapy setting accurate modelling is challenging (TPS) in the presence of patient being both heterogeneous and nonrectangular. Watertank-based measurements were made on a Varian TrueBeam linear accelerator covering electron beam energies 6 to 18 MeV. These included both normal and oblique incidence, heterogeneous geometries, and irregular shaped cut-outs. The measured geometries were replicated in RayStation and the Monte Carlo dose calculation engine used to generate dosimetric data for comparison against measurement in what were considered clinically relevant settings. Water-based PDDs and profile comparisons showed excellent agreement for all electron beam energies. Profiles measured with oblique beam incidence demonstrated acceptable agreement to the treatment planning system calculations although the correspondence worsened as the angle increased with the planning system overestimating the dose in the shoulder region. Profile measurements under inhomogeneities were generally good. The planning system had a tendency to overestimate dose under the heterogeneity and also demonstrated a broader penumbra than measurement. Of the 170 different output factors calculated in RayStation over the range of electron energies commissioned, 141 were within ± 3% of measured values and 164 within ± 5%. Four of the 6 comparisons beyond 5% were at 18 MeV and all had a cut-out edge within 3 cm of the beam central axis/measurement point. The RayStation implementation of a VMC++ electron Monte Carlo dose calculation algorithm shows good agreement with measured data for a range of scenarios studied and represented sufficient accuracy for clinical use.

Technical Note: On the use of cylindrical ionization chambers for electron beam reference dosimetry

PURPOSE

To investigate the use of cylindrical chambers for electron beam dosimetry independent of energy by studying the variability of relative ion chamber perturbation corrections, one of the main concerns for electron beam dosimetry with cylindrical chambers.

METHODS

Measurements are made with sets of cylindrical and plane-parallel reference-class chambers as a function of depth in water in 8 MeV and 18 MeV electron beams. The ratio of chamber readings for similar chambers is normalized in a high-energy electron beam and can be thought of as relative perturbation corrections. Data are plotted as a function of mean electron energy at depth for a range of depths close to the phantom surface to R₈₀ , the depth at which the ionization falls to 80% of its maximum value. Additional, similar measurements are made in a Virtual Water® phantom with cylindrical chambers at the reference depth in a 4 MeV electron beam.

RESULTS

The variability of relative ion chamber perturbation corrections for nominally identical cylindrical Farmer-type chambers is found to be less than 0.4%, no worse than plane-parallel chambers with similar specifications.

CONCLUSIONS

This work discusses several issues related to the use of plane-parallel ion chambers and suggests that reference-class cylindrical chambers may be appropriate for reference dosimetry of all electron beams. This would simplify the reference dosimetry procedure and improve accuracy of beam calibration.

Dosimetric properties of a Solid Water High Equivalency (SW557) phantom for megavoltage photon beams

The dosimetric properties of the recently developed SW557 phantom have been investigated by comparison with those of the existing SW457 phantom in megavoltage photon beams. The electron fluence ratio φ_pl^w, and chamber ionization ratio k_pl, of water to SW457 and water to SW557 for 4-15MV photons were calculated as a function of depth using Monte Carlo simulations, and compared with measured values. Values of φ_pl^w for SW457 were in the range of 1.004-1.014 for 4MV, and 1.014-1.018 for 15MV photons. The φ_pl^w for SW557 ranged from 1.005 to 1.008 for 4MV and from 1.010 to 1.015 for 15MV photons and the variation of φ_pl^w with depth for each beam energy was within ±0.5%. Values of k_pl were obtained with a PTW 30013 Farmer-type ionization chamber. The k_pl for SW457 ranged from 0.997 to 1.011 for 4-15MV photons. Values of k_pl for SW557 were almost unity for 4 and 6MV photons, while in the case of 10 and 15MV photons they were less than 1.006, excepting the build-up region. The measured and calculated k_pl values of water to SW557 were in the range of 0.997-1.002 and 1.000-1.006, respectively, for 4-15MV photons, at a depth of 10cm with a source-to-axis distance of 100cm. The measured and calculated k_pl values were in agreement within their uncertainty ranges. As a water-equivalent phantom, SW557 can be used with a dosimetric difference within±0.6%, for 4-15MV photons, and is more water-equivalent than SW457 in megavoltage photon beams.

Challenges of dosimetry of ultra-short pulsed very high energy electron beams

Very high energy electrons (VHEE) in the range from 100 to 250MeV have the potential of becoming an alternative modality in radiotherapy because of their improved dosimetric properties compared with 6-20MV photons generated by clinical linear accelerators (LINACs). VHEE beams have characteristics unlike any other beams currently used for radiotherapy: femtosecond to picosecond duration electron bunches, which leads to very high dose per pulse, and energies that exceed that currently used in clinical applications. Dosimetry with conventional online detectors, such as ionization chambers or diodes, is a challenge due to non-negligible ion recombination effects taking place in the sensitive volumes of these detectors. FLUKA and Geant4 Monte Carlo (MC) codes have been employed to study the temporal and spectral evolution of ultrashort VHEE beams in a water phantom. These results are complemented by ion recombination measurements employing an IBA CC04 ionization chamber for a 165MeV VHEE beam. For comparison, ion recombination has also been measured using the same chamber with a conventional 20MeV electron beam. This work demonstrates that the IBA CC04 ionization chamber exhibits significant ion recombination and is therefore not suitable for dosimetry of ultrashort pulsed VHEE beams applying conventional correction factors. Further study is required to investigate the applicability of ion chambers in VHEE dosimetry.

Optical fibre sensors: their role in in vivo dosimetry for prostate cancer radiotherapy

Review is made of dosimetric studies of current optical fibre technology in radiotherapy for therapeutic applications, focusing particularly on in vivo dosimetry for prostate radiotherapy. We present the various sensor designs along with the main advantages and disadvantages associated with this technology. Optical fibres are ideally placed for applications in radiotherapy dosimetry; due to their small size they are lightweight and immune to electromagnetic interferences. The small dimensions of optical fibres allows it to be easily guided within existing brachytherapy equipment; for example, within the seed implantation needle for direct tumour dose analysis, in the urinary catheter to monitor urethral dose, or within the biopsy needle holder of the transrectal ultrasound probe to monitor rectal wall dose. The article presents the range of optical fibre dosimeter designs along with the main dosimetric properties required for a modern in vivo dosimetry system to be utilised in a clinical environment.

Radiotherapy dosimetry audit: three decades of improving standards and accuracy in UK clinical practice and trials

Dosimetry audit plays an important role in the development and safety of radiotherapy. National and large scale audits are able to set, maintain and improve standards, as well as having the potential to identify issues which may cause harm to patients. They can support implementation of complex techniques and can facilitate awareness and understanding of any issues which may exist by benchmarking centres with similar equipment. This review examines the development of dosimetry audit in the UK over the past 30 years, including the involvement of the UK in international audits. A summary of audit results is given, with an overview of methodologies employed and lessons learnt. Recent and forthcoming more complex audits are considered, with a focus on future needs including the arrival of proton therapy in the UK and other advanced techniques such as four-dimensional radiotherapy delivery and verification, stereotactic radiotherapy and MR linear accelerators. The work of the main quality assurance and auditing bodies is discussed, including how they are working together to streamline audit and to ensure that all radiotherapy centres are involved. Undertaking regular external audit motivates centres to modernize and develop techniques and provides assurance, not only that radiotherapy is planned and delivered accurately but also that the patient dose delivered is as prescribed.

A review of recent advances in optical fibre sensors for in vivo dosimetry during radiotherapy

This article presents an overview of the recent developments and requirements in radiotherapy dosimetry, with particular emphasis on the development of optical fibre dosemeters for radiotherapy applications, focusing particularly on in vivo applications. Optical fibres offer considerable advantages over conventional techniques for radiotherapy dosimetry, owing to their small size, immunity to electromagnetic interferences, and suitability for remote monitoring and multiplexing. The small dimensions of optical fibre-based dosemeters, together with being lightweight and flexible, mean that they are minimally invasive and thus particularly suited to in vivo dosimetry. This means that the sensor can be placed directly inside a patient, for example, for brachytherapy treatments, the optical fibres could be placed in the tumour itself or into nearby critical tissues requiring monitoring, via the same applicators or needles used for the treatment delivery thereby providing real-time dosimetric information. The article outlines the principal sensor design systems along with some of the main strengths and weaknesses associated with the development of these techniques. The successful demonstration of these sensors in a range of different clinical environments is also presented.

Comparative dosimetry study of three UK centres implementing total skin electron treatment through external audit

OBJECTIVE

This article describes the external audit measurements conducted in two UK centres implementing total skin electron beam therapy (TSEBT) and the results obtained.

METHODS

Measurements of output, energy, beam flatness and symmetry at a standard distance (95 or 100 cm SSD) were performed using a parallel plate chamber in solid water. Similarly, output and energy measurements were also performed at the treatment plane for single and dual fields. Clinical simulations were carried out using thermoluminescent dosemeters (TLDs) and Gafchromic® film (International Specialty Products, Wayne, NJ) on an anthropomorphic phantom.

RESULTS

Extended distance measurements confirmed that local values for the beam dosimetry at Centres A and B were within 2% for outputs and 1-mm agreement of the expected depth at which the dose is 50% of the maximum for the depth-dose curve in water (R50,D) value. Clinical simulation using TLDs) showed an agreement of -1.6% and -6.7% compared with the expected mean trunk dose for each centre, respectively, and a variation within 10% (±1 standard deviation) across the trunk. The film results confirmed that the delivery of the treatment technique at each audited centre complies with the European Organisation for Research and Treatment of Cancer recommendations.

CONCLUSION

This audit methodology has proven to be a successful way to confirm the agreement of dosimetric parameters for TSEBT treatments at both audited centres and could serve as the basis for an audit template to be used by other audit groups.

ADVANCES IN KNOWLEDGE

TSEBT audits are not established in the UK owing to a limited number of centres carrying out the treatment technique. This article describes the audits performed at two UK centres prior to their clinical implementation.

Roos and NACP-02 ion chamber perturbations and water-air stopping-power ratios for clinical electron beams for energies from 4 to 22 MeV

Empirical fits are developed for depth-compensated wall- and cavity-replacement perturbations in the PTW Roos 34001 and IBA / Scanditronix NACP-02 parallel-plate ionisation chambers, for electron beam qualities from 4 to 22 MeV for depths up to approximately 1.1 × R₅₀,D. These are based on calculations using the Monte Carlo radiation transport code EGSnrc and its user codes with a full simulation of the linac treatment head modelled using BEAMnrc. These fits are used with calculated restricted stopping-power ratios between air and water to match measured depth-dose distributions in water from an Elekta Synergy clinical linear accelerator at the UK National Physical Laboratory. Results compare well with those from recent publications and from the IPEM 2003 electron beam radiotherapy Code of Practice.

Direct megavoltage photon calibration service in Australia

The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) maintains the Australian primary standard of absorbed dose. Until recently, the standard was used to calibrate ionisation chambers only in (60)Co gamma rays. These chambers are then used by radiotherapy clinics to determine linac output, using a correction factor (k Q) to take into account the different spectra of (60)Co and the linac. Over the period 2010-2013, ARPANSA adapted the primary standard to work in megavoltage linac beams, and has developed a calibration service at three photon beams (6, 10 and 18 MV) from an Elekta Synergy linac. We describe the details of the new calibration service, the method validation and the use of the new calibration factors with the International Atomic Energy Agency's TRS-398 dosimetry Code of Practice. The expected changes in absorbed dose measurements in the clinic when shifting from (60)Co to the direct calibration are determined. For a Farmer chamber (model 2571), the measured chamber calibration coefficient is expected to be reduced by 0.4, 1.0 and 1.1 % respectively for these three beams when compared to the factor derived from (60)Co. These results are in overall agreement with international absorbed dose standards and calculations by Muir and Rogers in 2010 of k Q factors using Monte Carlo techniques. The reasons for and against moving to the new service are discussed in the light of the requirements of clinical dosimetry.

Monte Carlo study of the depth-dependent fluence perturbation in parallel-plate ionization chambers in electron beams

PURPOSE

The electron fluence inside a parallel-plate ionization chamber positioned in a water phantom and exposed to a clinical electron beam deviates from the unperturbed fluence in water in absence of the chamber. One reason for the fluence perturbation is the well-known "inscattering effect," whose physical cause is the lack of electron scattering in the gas-filled cavity. Correction factors determined to correct for this effect have long been recommended. However, more recent Monte Carlo calculations have led to some doubt about the range of validity of these corrections. Therefore, the aim of the present study is to reanalyze the development of the fluence perturbation with depth and to review the function of the guard rings.

METHODS

Spatially resolved Monte Carlo simulations of the dose profiles within gas-filled cavities with various radii in clinical electron beams have been performed in order to determine the radial variation of the fluence perturbation in a coin-shaped cavity, to study the influences of the radius of the collecting electrode and of the width of the guard ring upon the indicated value of the ionization chamber formed by the cavity, and to investigate the development of the perturbation as a function of the depth in an electron-irradiated phantom. The simulations were performed for a primary electron energy of 6 MeV.

RESULTS

The Monte Carlo simulations clearly demonstrated a surprisingly large in- and outward electron transport across the lateral cavity boundary. This results in a strong influence of the depth-dependent development of the electron field in the surrounding medium upon the chamber reading. In the buildup region of the depth-dose curve, the in-out balance of the electron fluence is positive and shows the well-known dose oscillation near the cavity/water boundary. At the depth of the dose maximum the in-out balance is equilibrated, and in the falling part of the depth-dose curve it is negative, as shown here the first time. The influences of both the collecting electrode radius and the width of the guard ring are reflecting the deep radial penetration of the electron transport processes into the gas-filled cavities and the need for appropriate corrections of the chamber reading. New values for these corrections have been established in two forms, one converting the indicated value into the absorbed dose to water in the front plane of the chamber, the other converting it into the absorbed dose to water at the depth of the effective point of measurement of the chamber. In the Appendix, the in-out imbalance of electron transport across the lateral cavity boundary is demonstrated in the approximation of classical small-angle multiple scattering theory.

CONCLUSIONS

The in-out electron transport imbalance at the lateral boundaries of parallel-plate chambers in electron beams has been studied with Monte Carlo simulation over a range of depth in water, and new correction factors, covering all depths and implementing the effective point of measurement concept, have been developed.

Review on the characteristics of radiation detectors for dosimetry and imaging

The enormous advances in the understanding of human anatomy, physiology and pathology in recent decades have led to ever-improving methods of disease prevention, diagnosis and treatment. Many of these achievements have been enabled, at least in part, by advances in ionizing radiation detectors. Radiology has been transformed by the implementation of multi-slice CT and digital x-ray imaging systems, with silver halide films now largely obsolete for many applications. Nuclear medicine has benefited from more sensitive, faster and higher-resolution detectors delivering ever-higher SPECT and PET image quality. PET/MR systems have been enabled by the development of gamma ray detectors that can operate in high magnetic fields. These huge advances in imaging have enabled equally impressive steps forward in radiotherapy delivery accuracy, with 4DCT, PET and MRI routinely used in treatment planning and online image guidance provided by cone-beam CT. The challenge of ensuring safe, accurate and precise delivery of highly complex radiation fields has also both driven and benefited from advances in radiation detectors. Detector systems have been developed for the measurement of electron, intensity-modulated and modulated arc x-ray, proton and ion beams, and around brachytherapy sources based on a very wide range of technologies. The types of measurement performed are equally wide, encompassing commissioning and quality assurance, reference dosimetry, in vivo dosimetry and personal and environmental monitoring. In this article, we briefly introduce the general physical characteristics and properties that are commonly used to describe the behaviour and performance of both discrete and imaging detectors. The physical principles of operation of calorimeters; ionization and charge detectors; semiconductor, luminescent, scintillating and chemical detectors; and radiochromic and radiographic films are then reviewed and their principle applications discussed. Finally, a general discussion of the application of detectors for x-ray nuclear medicine and ion beam imaging and dosimetry is presented.

Determination of relative ion chamber calibration coefficients from depth-ionization measurements in clinical electron beams

A method is presented to obtain ion chamber calibration coefficients relative to secondary standard reference chambers in electron beams using depth-ionization measurements. Results are obtained as a function of depth and average electron energy at depth in 4, 8, 12 and 18 MeV electron beams from the NRC Elekta Precise linac. The PTW Roos, Scanditronix NACP-02, PTW Advanced Markus and NE 2571 ion chambers are investigated. The challenges and limitations of the method are discussed. The proposed method produces useful data at shallow depths. At depths past the reference depth, small shifts in positioning or drifts in the incident beam energy affect the results, thereby providing a built-in test of incident electron energy drifts and/or chamber set-up. Polarity corrections for ion chambers as a function of average electron energy at depth agree with literature data. The proposed method produces results consistent with those obtained using the conventional calibration procedure while gaining much more information about the behavior of the ion chamber with similar data acquisition time. Measurement uncertainties in calibration coefficients obtained with this method are estimated to be less than 0.5%. These results open up the possibility of using depth-ionization measurements to yield chamber ratios which may be suitable for primary standards-level dissemination.

Effective point of measurement for parallel plate and cylindrical ion chambers in megavoltage electron beams

The presence of an air filled ionization chamber in a surrounding medium introduces several fluence perturbations in high energy photon and electron beams which have to be accounted for. One of these perturbations, the displacement effect, may be corrected in two different ways: by a correction factor pdis or by the application of the concept of the effective point of measurement (EPOM). The latter means, that the volume averaged ionization within the chamber is not reported to the chambers reference point but to a point within the air filled cavity. Within this study the EPOM was determined for four different parallel plate and two cylindrical chambers in megavoltage electron beams using Monte Carlo simulations. The positioning of the chambers with this EPOM at the depth of measurement results in a largely depth independent residual perturbation correction, which is determined within this study for the first time. For the parallel plate chambers the EPOM is independent of the energy of the primary electrons. Whereas for the Advanced Markus chamber the position of the EPOM coincides with the chambers reference point, it is shifted for the other parallel plate chambers several tenths of millimeters downstream the beam direction into the air filled cavity. For the cylindrical chambers there is an increasing shift of the EPOM with increasing electron energy. This shift is in upstream direction, i.e. away from the chambers reference point toward the focus. For the highest electron energy the position of the calculated EPOM is in fairly good agreement with the recommendation given in common dosimetry protocols, for the smallest energy, the calculated EPOM positions deviate about 30% from this recommendation.

Monte Carlo N Particle code - Dose distribution of clinical electron beams in inhomogeneous phantoms

Electron dose distributions calculated using the currently available analytical methods can be associated with large uncertainties. The Monte Carlo method is the most accurate method for dose calculation in electron beams. Most of the clinical electron beam simulation studies have been performed using non- MCNP [Monte Carlo N Particle] codes. Given the differences between Monte Carlo codes, this work aims to evaluate the accuracy of MCNP4C-simulated electron dose distributions in a homogenous phantom and around inhomogeneities. Different types of phantoms ranging in complexity were used; namely, a homogeneous water phantom and phantoms made of polymethyl methacrylate slabs containing different-sized, low- and high-density inserts of heterogeneous materials. Electron beams with 8 and 15 MeV nominal energy generated by an Elekta Synergy linear accelerator were investigated. Measurements were performed for a 10 cm × 10 cm applicator at a source-to-surface distance of 100 cm. Individual parts of the beam-defining system were introduced into the simulation one at a time in order to show their effect on depth doses. In contrast to the first scattering foil, the secondary scattering foil, X and Y jaws and applicator provide up to 5% of the dose. A 2%/2 mm agreement between MCNP and measurements was found in the homogenous phantom, and in the presence of heterogeneities in the range of 1-3%, being generally within 2% of the measurements for both energies in a "complex" phantom. A full-component simulation is necessary in order to obtain a realistic model of the beam. The MCNP4C results agree well with the measured electron dose distributions.

Analysis of regional radiotherapy dosimetry audit data and recommendations for future audits

OBJECTIVES

Regional interdepartmental dosimetry audits within the UK provide basic assurances of the dosimetric accuracy of radiotherapy treatments.

METHODS

This work reviews several years of audit results from the South East Central audit group including megavoltage (MV) and kilovoltage (kV) photons, electrons and iodine-125 seeds.

RESULTS

Apart from some minor systematic errors that were resolved, the results of all audits have been within protocol tolerances, confirming the long-term stability and agreement of basic radiation dosimetric parameters between centres in the audit region. There is some evidence of improvement in radiation dosimetry with the adoption of newer codes of practice.

CONCLUSION

The value of current audit methods and the limitations of peer-to-peer auditing is discussed, particularly the influence of the audit schedule on the results obtained, where no "gold standard" exists. Recommendations are made for future audits, including an essential requirement to maintain the monitoring of basic fundamental dosimetry, such as MV photon and electron output, but audits must also be developed to include new treatment technologies such as image-guided radiotherapy and address the most common sources of error in radiotherapy.

On the wall perturbation correction for a parallel-plate NACP-02 chamber in clinical electron beams

PURPOSE

In recent years, several Monte Carlo studies have been published concerning the perturbation corrections of a parallel-plate chamber in clinical electron beams. In these studies, a strong depth dependence of the relevant correction factors (p(wall) and P(cav)) for depth beyond the reference depth is recognized and it has been shown that the variation with depth is sensitive to the choice of the chamber's effective point of measurement. Recommendations concerning the positioning of parallel-plate ionization chambers in clinical electron beams are not the same for all current dosimetry protocols. The IAEA TRS-398 as well as the IPEM protocol and the German protocol DIN 6800-2 interpret the depth of measurement within the phantom as the water equivalent depth, i.e., the nonwater equivalence of the entrance window has to be accounted for by shifting the chamber by an amount deltaz. This positioning should ensure that the primary electrons traveling from the surface of the water phantom through the entrance window to the chamber's reference point sustain the same energy loss as the primary electrons in the undisturbed phantom. The objective of the present study is the determination of the shift deltaz for a NACP-02 chamber and the calculation of the resulting wall perturbation correction as a function of depth. Moreover, the contributions of the different chamber walls to the wall perturbation correction are identified.

METHODS

The dose and fluence within the NACP-02 chamber and a wall-less air cavity is calculated using the Monte Carlo code EGSnrc in a water phantom at different depths for different clinical electron beams. In order to determine the necessary shift to account for the nonwater equivalence of the entrance window, the chamber is shifted in steps deltaz around the depth of measurement. The optimal shift deltaz is determined from a comparison of the spectral fluence within the chamber and the bare cavity. The wall perturbation correction is calculated as the ratio between doses for the complete chamber and a wall-less air cavity.

RESULTS

The high energy part of the fluence spectra within the chamber strongly varies even with small chamber shifts, allowing the determination of deltaz within micrometers. For the NACP-02 chamber a shift deltaz = -0.058 cm results. This value is independent of the energy of the primary electrons as well as of the depth within the phantom and it is in good agreement with the value recommended in the German dosimetry protocol. Applying this shift, the calculated wall perturbation correction as a function of depth is varying less than 1% from zero up to the half value depth R50 for electron energies in the range of 6-21 MeV. The remaining depth dependence can mainly be attributed to the scatter properties of the entrance window. When neglecting the nonwater equivalence of the entrance window, the variation of p(wall) with depth is up to 10% and more, especially for low electron energies.

CONCLUSIONS

The variation of the wall perturbation correction for the NACP-02 chamber in clinical electron beams strongly depends on the positioning of the chamber. Applying a shift deltaz = -0.058 cm toward the focus ensures that the primary electron spectrum within the chamber bears the largest resemblance to the fluence of a wall-less cavity. Hence, the influence of the chamber walls on the perturbation correction can be separated out and the residual variation of p(wall) with depth is minimized.

Analysis of output trends from Varian 2100C/D and 600C/D accelerators

Analysis of Varian linear accelerator output trends is reported. Two groups, consisting of four matched Varian 2100C/D and four matched Varian 600C/D accelerators, with different designs of monitor chamber, have been investigated and the data acquired from regular calibrated ion chamber/electrometer measurements of the output performance of the eight accelerators analysed. The trend of machine output with time, having removed the effect of adjusting the monitor chamber response, was compared on a monthly and annual basis for monitor chambers with ages ranging between 1 year and 7 years. The results indicate that the response is generally consistent within each set of accelerators with different monitor chamber designs. Those used in a Varian 600C/D machine result in a reduction in measured output over time, with an average monthly reduction of 0.35 ± 0.09% over the course of the first 4 years of use. The chambers used in a 2100C/D accelerator result in an increase in measured output over time, with an average monthly increase of 0.26 ± 0.09% over the course of the first 4 years of use. The output increase then reduces towards the end of this period of time, with the average monthly change falling to -0.03 ± 0.02% for the following 3 years. The output response trend was similar for all clinical energies used on the 2100C/D accelerators--6, 15 MV x-ray beams, and 4, 6, 9, 12, 16 and 20 MeV electron beams. By tracking these changes it has been possible to predict the response over time to allow appropriate adjustments in monitor chamber response to maintain a measured accelerator output within tolerance and give confidence in performance. It has also provided data to indicate the need for planned preventative intervention and indicate if the monitor chamber response is behaving as expected.

Extraction of depth-dependent perturbation factors for parallel-plate chambers in electron beams using a plastic scintillation detector

PURPOSE

This work presents the experimental extraction of the overall perturbation factor PQ in megavoltage electron beams for NACP-02 and Roos parallel-plate ionization chambers using a plastic scintillation detector (PSD).

METHODS

The authors used a single scanning PSD mounted on a high-precision scanning tank to measure depth-dose curves in 6, 12, and 18 MeV clinical electron beams. The authors also measured depth-dose curves using the NACP-02 and PTW Roos chambers.

RESULTS

The authors found that the perturbation factors for the NACP-02 and Roos chambers increased substantially with depth, especially for low-energy electron beams. The experimental results were in good agreement with the results of Monte Carlo simulations reported by other investigators. The authors also found that using an effective point of measurement (EPOM) placed inside the air cavity reduced the variation of perturbation factors with depth and that the optimal EPOM appears to be energy dependent.

CONCLUSIONS

A PSD can be used to experimentally extract perturbation factors for ionization chambers. The dosimetry protocol recommendations indicating that the point of measurement be placed on the inside face of the front window appear to be incorrect for parallel-plate chambers and result in errors in the R50 of approximately 0.4 mm at 6 MeV, 1.0 mm at 12 MeV, and 1.2 mm at 18 MeV.

Monitoring linear accelerator output constancy using the PTW Linacheck

The PTW-Linacheck was assessed for its ability to monitor linear accelerator radiation output constancy. The key issues that were considered were the setup for daily output measurements, e.g., requirements for build-up and backscatter material, and the reproducibility and linearity of the device with linear accelerator output. An appropriate measurement setup includes a 10 × 10 cm field at 100 cm FSD, 5 cm backscatter, and no added build-up for 4 MeV electron beams, 1 cm added build-up for 6-16 MeV electron beams and 5 cm added build-up for 6-15 MV photon beams. Using this measurement setup, the dose linearity and short-term reproducibility were acceptable; however, the Linacheck should be recalibrated on a monthly basis to ensure acceptable long-term reproducibility.

Recommendations for clinical electron beam dosimetry: supplement to the recommendations of Task Group 25

The goal of Task Group 25 (TG-25) of the Radiation Therapy Committee of the American Association of.Physicists in Medicine (AAPM) was to provide a methodology and set of procedures for a medical physicist performing clinical electron beam dosimetry in the nominal energy range of 5-25 MeV. Specifically, the task group recommended procedures for acquiring basic information required for acceptance testing and treatment planning of new accelerators with therapeutic electron beams. Since the publication of the TG-25 report, significant advances have taken place in the field of electron beam dosimetry, the most significant being that primary standards laboratories around the world have shifted from calibration standards based on exposure or air kerma to standards based on absorbed dose to water. The AAPM has published a new calibration protocol, TG-51, for the calibration of high-energy photon and electron beams. The formalism and dosimetry procedures recommended in this protocol are based on the absorbed dose to water calibration coefficient of an ionization chamber at 60Co energy, N60Co(D,w), together with the theoretical beam quality conversion coefficient k(Q) for the determination of absorbed dose to water in high-energy photon and electron beams. Task Group 70 was charged to reassess and update the recommendations in TG-25 to bring them into alignment with report TG-51 and to recommend new methodologies and procedures that would allow the practicing medical physicist to initiate and continue a high quality program in clinical electron beam dosimetry. This TG-70 report is a supplement to the TG-25 report and enhances the TG-25 report by including new topics and topics that were not covered in depth in the TG-25 report. These topics include procedures for obtaining data to commission a treatment planning computer, determining dose in irregularly shaped electron fields, and commissioning of sophisticated special procedures using high-energy electron beams. The use of radiochromic film for electrons is addressed, and radiographic film that is no longer available has been replaced by film that is available. Realistic stopping-power data are incorporated when appropriate along with enhanced tables of electron fluence data. A larger list of clinical applications of electron beams is included in the full TG-70 report available at http://www.aapm.org/pubs/reports. Descriptions of the techniques in the clinical sections are not exhaustive but do describe key elements of the procedures and how to initiate these programs in the clinic. There have been no major changes since the TG-25 report relating to flatness and symmetry, surface dose, use of thermoluminescent dosimeters or diodes, virtual source position designation, air gap corrections, oblique incidence, or corrections for inhomogeneities. Thus these topics are not addressed in the TG-70 report.

Monte Carlo calculations of correction factors for plastic phantoms in clinical photon and electron beam dosimetry

The purpose of this study is to calculate correction factors for plastic water (PW) and plastic water diagnostic-therapy (PWDT) phantoms in clinical photon and electron beam dosimetry using the EGSnrc Monte Carlo code system. A water-to-plastic ionization conversion factor k(pl) for PW and PWDT was computed for several commonly used Farmer-type ionization chambers with different wall materials in the range of 4-18 MV photon beams. For electron beams, a depth-scaling factor c(pl) and a chamber-dependent fluence correction factor h(pl) for both phantoms were also calculated in combination with NACP-02 and Roos plane-parallel ionization chambers in the range of 4-18 MeV. The h(pl) values for the plane-parallel chambers were evaluated from the electron fluence correction factor phi(pl)w and wall correction factors P(wall,w) and P(wall,pl) for a combination of water or plastic materials. The calculated k(pl) and h(pl) values were verified by comparison with the measured values. A set of k(pl) values computed for the Farmer-type chambers was equal to unity within 0.5% for PW and PWDT in photon beams. The k(pl) values also agreed within their combined uncertainty with the measured data. For electron beams, the c(pl) values computed for PW and PWDT were from 0.998 to 1.000 and from 0.992 to 0.997, respectively, in the range of 4-18 MeV. The phi(pl)w values for PW and PWDT were from 0.998 to 1.001 and from 1.004 to 1.001, respectively, at a reference depth in the range of 4-18 MeV. The difference in P(wall) between water and plastic materials for the plane-parallel chambers was 0.8% at a maximum. Finally, h(pl) values evaluated for plastic materials were equal to unity within 0.6% for NACP-02 and Roos chambers. The h(pl) values also agreed within their combined uncertainty with the measured data. The absorbed dose to water from ionization chamber measurements in PW and PWDT plastic materials corresponds to that in water within 1%. Both phantoms can thus be used as a substitute for water for photon and electron dosimetry.

Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer

The purpose of this study was to compare conventional radiotherapy with parotid gland-sparing intensity-modulated radiation therapy (IMRT) using the PARSPORT trial. The validity of such a trial depends on the radiotherapy planning and delivery meeting a defined standard across all centres. At the outset, many of the centres had little or no experience of delivering IMRT; therefore, quality assurance processes were devised to ensure consistency and standardisation of all processes for comparison within the trial. The pre-trial quality assurance (QA) programme and results are described. Each centre undertook exercises in target volume definition and treatment planning, completed a resource questionnaire and produced a process document. Additionally, the QA team visited each participating centre. Each exercise had to be accepted before patients could be recruited into the trial. 10 centres successfully completed the quality assurance exercises. A range of treatment planning systems, linear accelerators and delivery methods were used for the planning exercises, and all the plans created reached the standard required for participation in this multicentre trial. All 10 participating centres achieved implementation of a comprehensive and robust IMRT programme for treatment of head and neck cancer.

Practical experience of using the IPEM 2003 electron code of practice

From 1 January 2007, the Institute of Physics and Engineering in Medicine (IPEM) 2003 code of practice (COP) for electron dosimetry replaces the old air kerma-based Institute of Physics and Engineering in Medicine and Biology 1996 COP as the recommended protocol for the UK. The IPEM 2003 COP requires a secondary standard ionisation chamber calibrated directly in terms of absorbed dose to water. This paper examines the differences between the new and old COP and indicates that the dose measured using the 2003 COP appears to be greater than that using the 1996 COP by approximately 2+/-1%, based on a survey of radiotherapy centres in the UK. The paper also compares the characteristics of the NACP (Scanditronix) and Roos (PTW) chambers recommended by the 2003 COP. No practical difference was found between adopting the NACP or Roos chambers as a secondary standard chamber.